| NPI | 1174676993 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KIM PELLEGRINO Program Billing Specialist 407-422-0880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2020-08-22 |